You Be the Coder:
Different Physician Discharge
Published on Fri Feb 01, 2002
Test your coding knowledge. Determine how you would code this situation before looking at the box below for the answer.
Question: Dr. A fills out the discharge forms for a patient who is expected to be discharged Friday. It turns out the patient is discharged Saturday, and the discharge is handled by Dr. B, the attending physician that day. Who should bill for the hospital discharge, and what does the other doctor report?
Minnesota Subscriber
Answer: Dr. B should bill for the discharge (99238-99239) since he or she was the one who was actually present and prepared the patient's discharge, according to Mary Falbo, MBA, CPC, president of Millennium Healthcare Consulting Inc. in Lansdale, Pa. The hospital discharge codes are used to report all services provided to a patient on the day of discharge. These are time-based codes and may include services such as the final examination of the patient, instructions for continuing care and the dictation of discharge records.
Although Dr. B may reference Dr. A's original notes and append them to the final discharge records, he or she will be the one to explain why the patient was discharged a day later. Dr. B will also have to provide the necessary documentation to support the medical necessity for the extra day stay.
Dr. A may bill for the subsequent hospital-care visit (99231-99233) if appropriate and medically necessary for his or her visit on Friday. These are not time-based like the discharge codes, but are dependent on the level of history, examination and medical decision-making that occurred on the day before discharge.
The tricky part in this is getting paid. CPT does not specify that the admitting physician must be the one to do the discharge. According to the American Medical Association publication Principles of CPT Coding, attending physicians may use the hospital-discharge services codes (99238-99239). In practice, however, Medicare and other payers have been known to deny the hospital admission and entire hospital stay if anyone other than the admitting physician performs the discharge. Your practice needs to talk with the payer to determine its particular policy.
